Health status and cognitive function for risk stratification in chronic coronary and peripheral artery disease

Kim G. Smolderen, Carlos Mena-Hurtado, John W. Eikelboom, Jackie Bosch, Feng Xie, Chinthanie Ramasundarahettige, Deepak L. Bhatt, Sonia S. Anand

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background and aims It is unclear whether health status and cognitive function assessments can augment traditional coronary artery disease (CAD) and peripheral artery disease (PAD) biomedical risk prediction frameworks. We examined the association between health status and cognitive function and subsequent adverse cardiovascular and limb events in CAD and PAD. Methods and results Stable CAD and PAD patients from the international, multi-centre COMPASS trial completed the visual analogue scale (VAS) of the EQ-5D-3L to assess overall health status, and the Digit Symbol Substitution test (DSST) to assess cognitive function. Main outcomes were incident development of major adverse cardiovascular events, and the combined endpoint major adverse cardiovascular or limb events. The EQ VAS (per 10 unit increase) and DSST (per 5 unit increase) were added to fully adjusted (medications, demographics, cardiovascular history and risk factors) hierarchical Cox regression models. A total of 23 433 patients were in the CAD cohort and 6899 in the PAD cohort. Among both the CAD and PAD groups, higher scores on the EQ VAS (CAD: HR = 0.89, 95%CI 0.88–0.89; PAD HR = 0.89, 95%CI 0.88–0.89) and DSST (CAD HR = 0.95, 95%CI 0.94–0.95) (PAD HR = 0.95, 95%CI 0.94–0.95) were associated with a lower risk of a major adverse cardiovascular or limb events. Population attributable risks associated with the lower two quartiles vs. upper quartiles for the EQ-5D and DSST scores were 7% and 16%, respectively in the CAD cohort; and for PAD, at 14% and 18%, respectively. Conclusions Adding health status and cognitive functioning information to biomedical evaluations can augment cardiovascular risk-stratification in CAD and PAD.

Original languageEnglish
Pages (from-to)535-545
Number of pages11
JournalEuropean Journal of Preventive Cardiology
Volume30
Issue number7
DOIs
StatePublished - 1 May 2023
Externally publishedYes

Keywords

  • Cardiovascular outcomes
  • Cognitive functioning
  • Health status
  • Risk stratification

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